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Late and long-term effects of treatment for non-Hodgkin lymphoma in children

Because of major advances in treatment, most children treated for lymphoma are living into adulthood, so their health as they get older has come more into focus in recent years.

Just as the treatment of childhood lymphoma requires a very specialized approach, so does follow-up and monitoring for late effects of treatment. Careful follow-up after treatment is very important. The earlier problems are recognized, the more likely it is they can be treated effectively.

Childhood lymphoma survivors are at risk, to some degree, for several possible late effects of their cancer treatment. This risk depends on a number of factors, such as the type of lymphoma, the type of treatments they received, dosages of cancer treatment, and age at the time treatment. It’s important to discuss what these possible effects might be with your child’s medical team so you know what to watch for and report to the doctor.

Late effects of treatment can include:

Heart or lung problems after getting certain chemotherapy drugs or getting radiation therapy to the chest

Slowed or decreased growth and development (especially after a stem cell transplant)

Bone damage or thinning of bones (osteoporosis)

Changes in sexual development and ability to have children (see below)

Cancer treatment might affect sexual development and ability to have children later in life. Talk with your child’s cancer care team about the risk of treatment affecting fertility, and ask if there are options for preserving fertility. For more information, see our documents Fertility and Women With Cancer and Fertility and Men With Cancer.

There may be other possible complications from treatment as well. Your child’s doctor should carefully review any possible problems with you before your child starts treatment.

Along with physical side effects, survivors of childhood cancer may have emotional or psychological issues. They also may have some problems with normal functioning and school work. These can often be addressed with support and encouragement. Doctors and other members of the health care team can also often recommend special support programs and services to help children after cancer treatment.

Long-term follow-up guidelines

To help increase awareness of late effects and improve follow-up care for childhood cancer survivors throughout their lives, the Children’s Oncology Group (COG) has developed long-term follow-up guidelines for survivors of childhood cancers. These guidelines can help you know what to watch for, what types of screening tests should be done, and how late effects may be treated.

It is very important to discuss possible long-term complications with your child’s health care team, and to make sure there is a plan in place to watch for these problems and treat them, if needed. To learn more, ask your child’s doctors about the COG survivor guidelines. You can also download them for free at the COG website: www.survivorshipguidelines.org. The guidelines are written for health care professionals. Patient versions of some of the guidelines are available (as “Health Links”) on the site as well, but we urge you to discuss them with a doctor.